Serial Changes of Liver Function Tests before and during Methimazole Treatment in Thyrotoxic Patients |
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| Affiliation: | 1. From Carol Davila University of Medicine and Pharmacy, Department of Endocrinology, Bucharest, Romania;2. C.I. Parhon Institute of Endocrinology, Department of Pituitary and Neuroendocrine Disorders, Bucharest, Romania.;1. From the Comenius University Faculty of Medicine, 5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia;2. Department of Medicine, University of Wisconsin, Madison, Wisconsin;3. National Institute of Endocrinology and Diabetology, L''ubochňa, Slovakia.;1. Center for Integrated Molecular Brain Imaging, Blegdamsvej 9, 2100 Copenhagen, Rigshospitalet, University of Copenhagen, Denmark;2. Department of Endocrinology, Hvidovre University Hospital, Denmark;3. Institute of Public Health and Center for Healthy Aging, University of Copenhagen, Denmark;4. Neurobiology Research Unit, Blegdamsvej 9, 2100Copenhagen, Rigshospitalet, University of Copenhagen, Denmark |
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| Abstract: | Objective: Overt hyperthyroidism and methimazole (MMI) treatment are frequently associated with abnormal liver function tests (LFTs). We describe the serial changes of LFTs in MMI-treated hyperthyroid patients.Methods: We retrospectively analyzed all 77 patients presenting with newly diagnosed overt hyperthyroidism (59 Graves diseases, 11 toxic nodular goiters, 4 toxic adenomas, 3 amiodarone-induced thyrotoxicosis) between 2012 and 2014. All patients started MMI at 10 to 60 mg/day that was gradually tapered. We measured thyroid-stimulating hormone, free thyroxine, alanine aminotransferase (ALT) and aspartate aminotrasnferase (AST) at baseline and at 6 weeks, 4.5 months and 10 months after starting the MMI treatment. The concomitant medication was stable during MMI treatment.Results: At baseline, 25 patients (32.5%) had abnormal LFT, of which 5 had ALT or AST levels >2× the upper limit of normal (ULN). In most patients with baseline abnormal LFT, MMI treatment resulted in a normalization of serum ALT and AST. Thirteen patients with normal baseline LFT had <2× the ULN elevations of LFT sometime during treatment. There was a case of significant hepatotoxicity. During treatment, there were no significant differences in LFT levels between patients with initially normal or abnormal LFT. In a Cox proportional hazard regression model, abnormal LFT at baseline, abnormal thyroid function at the last evaluation, and MMI dose were not predictors of abnormal LFT at the final evaluation.Conclusion: MMI treatment can induce insignificant LFT elevation, <2× the ULN. MMI can be safely administered in hyperthyroid patients with abnormal LFT, and normalization of increased AST and ALT levels should be anticipated.Abbreviations:ALT = alanine aminotransferaseAST = aspartate aminotransferasefT4 = free thyroxineHCV = hepatitis C virusLFT = liver function testLOCF = last observation carried forwardMMI = methimazolePTU = propylthiouracilTSH = thyroid-stimulating hormoneULN = upper limit of normal |
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